While smoking rates have been declining within the U.S. general population, many American Indians and Alaska Native tribes and communities are experiencing increasing rates of smoking. Indeed, smoking prevalence among older American Indians is the highest in the nation, with rates up to 45% in some communities -- a rate nearly 20% greater than that observed in the other populations. Studies have observed high rates of smoking among tribes from the Northern Plains, with rates as high as 62%. These disturbing rates of smoking put Amedcan Indian elders of the Northern Plains at a higher risk for cancer, myocardial infarction, and stroke. Despite these findings, fewer smoking cessation programs are available in this population. While many of the smoking cessation efforts among American Indians, these pdor efforts emphasized knowledge transfer, were not well-controlled, rarely employed nicotine replacement, and had weak outcome measures. Motivational interviewing, a promising patient-centered approach for improving treatment compliance in smoking cessation, has never been used in a systematic way among older American Indians. The overall goal of this research plan addresses these shortcomings by implementing a culturally appropriate smoking cessation intervention involving a theory-based behavioral change module among a group of older American Indians. To achieve this goal the following Specific Aims will be addressed: 1). To assess and document the comprehensibility, acceptability, and relevance of smoking cessation therapies, including motivational interviewing, among a group of older American Indians from the Northern Plains; 2). To use key thematic information generated from focus groups to enhance proven smoking cessation interventions that employ nicotine replacement and motivational interviewing technique making them culturally appropriate for American Indians; 3)To conduct a randomized controlled clinical trial of smoking cessation in older American Indians using culturally adapted interventions and the standardized outcome and mediator measures. Quitting smoking is the single behavior with the most impact on reducing morbidity and premature mortality. The need to develop, implement, and evaluate smoking cessation interventions for American Indian populations are clear and compelling. This project capitalizes on the unique strengths of the team's ethnocultural smoking cessation expertise, community-based, health orientation, and our excellent long-standing relationship with the Northern Plains tribe.